中国社会经济状况与老年人工具性日常生活能力关系的研究

在中国老年人口规模快速增长的同时,残疾人老年化和老年人残疾化的问题突显~([1]).社会经济状况(SES)是研究健康的重要视角,国外文献也总结出了两者之间的梯度关系,即SES越好,健康状况越好,反之亦然~([2,3]).     

老年人慢性病对日常生活功能的影响

目的：研究贵阳市城区老年慢性病人日常生活功能（ＡＤＬ和ＬＡＤＬ）的影响。方法：通过问卷问和体格检查相结合，对贵阳市我９６６名≥６０岁的老年人进行了慢性病和日常生活功能调查。运用非条件Ｌｏｇｉｓｔｉｃ回归分析有关慢性病对老年人日常生活功能损害原作用大小。结果：慢性病患病率为５７．８％，ＡＤＬ损害率为９．４％，ＩＡＤＬ损害率为２３．２％。对ＡＤＬ损害影响显著的疾病依次为脑血管疾病、白内障、慢性阻塞性肺     

Nutritional status and functional capacity of community-dwelling elderly in southern Laos

Objectives

The aim of this study was to assess the nutritional status and functional capacity of 144 community-dwelling elderly in three rural ethnic groups, namely, the Oy, the Brau and the Lao, of southern Laos.

Methods

The Mini nutritional assessment (MNA) questionnaire and Determine Your Nutritional Health checklist were used to assess nutritional status. The Barthel Activities of Daily Living questionnaire and Lawton and Brody’s Instrumental Activities of Daily Living questionnaire were used to assess the functional capacity of the respondents.

Results

The MNA score results indicated that 92.5 % of Oy respondents, 85.4 % of Brau respondents and 60 % of Lao respondents were malnourished. Analysis of variance tests showed that the MNA scores of the Oy and Lao ethnic groups and of the Brau and Lao ethnic groups were significantly different ( both p < 0.01), but that there was no significant difference between the MNA scores of the Oy and Brau ethnic groups (p > 0.05). In terms of functional capacity, 47.2 % of Oy respondents, 43.9 % of Brau respondents and 20 % of Lao respondents had limitations in their activities of daily living, whereas 98.1 % of Oy respondents, 97.6 % of Brau respondents and 86 % of Lao respondents had limitations in their instrumental activities of daily living. Body mass index, reduced appetite, number of meals consumed daily and presence of common diseases predicted nutritional status in all three ethnic groups; the remaining factors differed by ethnicity. This result implies that ethnic differences and other factors, such as location of the village, services, resources within the village and respondents’ lifestyles, can affect nutritional status.

Conclusions

Because predictors of nutritional status varied by ethnicity, there is a need for area-specific interventions aimed at improving the quality of life of the elderly in these areas.     

Variability in measuring (instrumental) activities of daily living functioning and functional decline in hospitalized older medical patients: a systematic review

Objective

To study instruments used and definitions applied in order to measure (instrumental) activities of daily living (I [ADL]) functioning and functional decline in hospitalized older medical patients.

Study Design

We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews from 1990 to January 2010. Articles were included if they (1) focused on acute hospitalization for medical illness in older patients; (2) described the instrument used to measure functioning; and (3) outlined the clinical definition of functional decline. Two reviewers independently extracted data.

Results

In total, 28 studies were included in this review. Five different instruments were used to measure functioning: the Katz ADL index, the IADL scale of Lawton and Brody, the Barthel index, Functional Independence Measure, and Care Needs Assessment. Item content and scoring between and within the instruments varied widely. The minimal amount for decline, as defined by the authors, referred to a decrease in functioning between 2.4% and 20.0%.

Conclusion

This review shows there is a large variability in measuring (I)ADL functioning of older hospitalized patients and a large range of clinical definitions of functional decline. These conceptual and clinimetric barriers hamper the interpretation and comparison of functional outcome data of epidemiological and clinical studies.     

The Occupation-Based Intervention of Bathing: Cases in Home Health Care

Abstract

Although bathing skills can be an indicator of long term placement, documentation of occupational therapists doing bathing as an occupation-based intervention is limited. Five clients were referred to a hospital-based home health agency with various diagnoses and at different levels of functioning. Each client was assessed at admission and discharge using the Outcomes and Assessment Information Set and the occupational therapists used the Activities of daily living (ADL) of bathing as the intervention based on client centered expressed needs. Findings reveal a statistically significant change in individuals pre- and post-assessment of bathing (Z?=?–2.032, p?=?.042) supporting occupation-based interventions, specifically bathing, should be further researched as a means of significantly improving the functional status of clients.     

Childhood socioeconomic status and racial differences in disability: Evidence from the Health and Retirement Study (1998–2006)

This study used a life course approach to examine the ways in which childhood socioeconomic status (SES) may account for some of the racial differences in disability in later life. Eight years (5 waves) of longitudinal data from the US Health and Retirement Study (HRS; 1998–2006), a nationally representative sample of community-dwelling Black and White Americans over age 50 (N = 14,588), were used in nonlinear multilevel models. Parental education and father's occupation were used to predict racial differences in activities of daily living (ADL) and instrumental activities of daily living (IADL). The role of adult SES (education, income, and wealth) and health behaviors (smoking, drinking alcohol, exercising, and being obese) were also examined and models were adjusted for health conditions (heart problems, diabetes, stroke, hypertension, cancer, lung disease, and arthritis). With the inclusion of childhood SES indicators, racial differences in ADL and IADL disability were reduced. Adult SES and health behaviors mediated some of the relationship between low childhood SES and disability, though low childhood SES continued to be associated with disability net of these. In support of a life course approach, these findings suggest that socioeconomic conditions in early life may have implications for racial differences in disability between older Black and older White adults.     

Knowledge of results and learning to tell the time in an adult male with an intellectual disability: a single-subject research design

The present study investigated whether knowledge of results, in the form of visual and audible feedback, would increase the accuracy of time-telling in an individual with an intellectual disability. A 19-year-old male with mild intellectual disability participated in this A1-B1-A2-B2 single-subject study design. The task involved correctly identifying the time given on a computer. Data, based on the Wilcoxon signed-rank test, showed that the participant demonstrated a greater number of correct responses during the intervention phases. Incorporating knowledge of results into a learning strategy for this individual with intellectual disability resulted in an increased ability to accurately identify the correct time on an analogue clock. There is a need to replicate the study design to increase the external validity and generalization of results. The strategies described in the present study may also be useful for occupational therapists who teach individuals with intellectual disability to gain skills in their everyday activities of daily living (ADLs).     

Elderly persons with disabilities in Sweden: their experiences of everyday life

The aim of this study was to describe the everyday life experiences of 22 elderly persons with physical disabilities in Sweden. The participants were aged between 65 and 91 years. Interviews were conducted and analysed according to a qualitative research approach. Disengagement in activities and social contacts resulted in feelings of resignation and dejection for some participants, while others delegated tasks as a satisfactory alternative. Participants also described how activities and social contacts continued, albeit in a different way, and being active and socializing gave feelings of pleasure and a sense of belonging. While receiving help was experienced as valuable, it also increased the fear of becoming dependent. Occupational therapy intervention should be directed at increasing social contacts and engagements in meaningful activities, as well as strengthening the individual's autonomy. The transferability of the study can be questioned as the sample only included elderly persons with physical disabilities from urban areas. Further research is needed to address the impact of occupational therapy interventions on life satisfaction.     

Occupational therapists’ perceptions of gender – A focus group study

Background/aim: Women and men are shaped over the courses of their lives by culture, society and human interaction according to the gender system. Cultural influences on individuals’ social roles and environment are described in occupational therapy literature, but not specifically from a gender perspective. The purpose of this qualitative study was to explore how a sample of occupational therapists perceives the ‘gender’ concept. Method: Four focus group interviews with 17 occupational therapists were conducted. The opening question was: ‘How do you reflect on the encounter with a client depending on whether it is a man or a woman?’ The transcribed interviews were analysed and two main themes emerged: ‘the concept of gender is tacit in occupational therapy’ and ‘client encounters’. Results: The occupational therapists expressed limited theoretical knowledge of ‘gender’. Furthermore, the occupational therapists seemed to be ‘doing gender’ in their encounters with the clients. For example, in their assessment of the client, they focussed their questions on different spheres: with female clients, on the household and family; with male clients, on their paid work. Conclusions: This study demonstrated that occupational therapists were unaware of the possibility that they were ‘doing gender’ in their encounters with clients. There is a need to increase occupational therapists’ awareness of their own behaviour of ‘doing gender’. Furthermore, there is a need to investigate whether gendered perceptions will shorten or lengthen a rehabilitation period and affect the chosen interventions, and in the end, the outcome for the clients.     

Evaluation of a Hand-training Programme for Patients with Welander Distal Myopathy

The aim of this pilot study was to evaluate hand-training for patients with Welander distal myopathy (WDM). Twelve patients participated in a three-month training programme with two self-training sessions and one session guided by an occupational therapist per week. Evaluation included hand function, activities of daily living (ADL) and life satisfaction. Hand function, i.e. motor function was evaluated, using manual Muscle Testing status (muscle strength), Grippit (grip strength and pinch grip including endurance), and standard finger goniometer (active extension). Activities of daily living were evaluated using the areas of the ADL taxonomy in a structured verbal interview. Life satisfaction was evaluated using a modified version of the Life Satisfaction Checklist. The results show that patients with WDM may improve their hand function and ADL after participating in a training programme. The results are discussed in relation to studies that have questioned whether patients with neuromuscular disease, i.e. WDM, benefit from hand training.     

The Influence of Prior Functional Status on Self-Care Improvement During a Skilled Nursing Facility Stay

ObjectivesOlder adults' prior health status can influence their recovery after a major illness. We investigated the association between older adults’ independence in self-care tasks prior to a skilled nursing facility (SNF) stay and their self-care function at SNF admission, discharge, and the change in self-care function during an SNF stay.DesignRetrospective study of 100% national CMS data files from October 1, 2018, to December 31, 2019.Settings and ParticipantsThe sample included 616,073 Medicare fee-for-service beneficiaries who were discharged from an SNF between October 1, 2018, and December 31, 2019.MethodsThe admission Minimum Data Set (MDS) was used to determine residents’ prior ability (independent, some help, dependent) to complete self-care tasks before the current illness, exacerbation, or injury. Seven self-care tasks from MDS Section GG were used to calculate total scores (range 7-42 points) for self-care at admission, discharge, and the change in self-care between admission and discharge.ResultsMost residents (62.0%) were independent, 35.3% needed some help, and 2.64% were dependent in self-care prior to SNF admission. Nearly 25% of residents with urinary incontinence, 28.8% with bowel incontinence, and 31.7% with moderate-severe cognitive impairment were independent in self-care prior to SNF admission compared with approximately 70% of residents without these conditions. Compared with residents who were dependent in self-care prior to SNF admission, those who were independent or needed some help had significantly higher self-care total scores at admission (5.67 vs 4.21 points, respectively) and discharge (6.44 vs 3.82 points, respectively) and exhibited greater improvement in self-care (3.48 vs 1.62 points, respectively).Conclusions and ImplicationsOur findings are evidence that the new MDS item for a resident's independence in self-care tasks before SNF admission is a valid measure of their prior self-care function. This is clinically useful information and should be considered when developing rehabilitation goals.     

Occupational Therapy Intervention: Effects on Self-Care,Performance, Satisfaction,Self-Esteem/Self-Efficacy,and Role Functioning of Older Hispanic Females with Arthritis

ABSTRACT

The purpose of this pilot study was to compare the effectiveness of occupation-based and enabling/preparatory interventions on self-care, perceived performance, satisfaction, self-efficacy, and role function among older Hispanic females with arthritis. A pre- and post-outcome measures design with semi-structured interview and questionnaire/rating scales was used with matched participants assigned to one of two intervention groups or a control, non-intervention group. For measures of task-specific functioning and self-efficacy, there were no statistically significant differences in average gain scores between the two interventions. Average gain scores were higher for the enabling/preparatory intervention than for the control group. For the occupational intervention, the scores were higher than for the control group for self-care/activities of daily living (ADL) functioning and self-esteem/self-efficacy. The results suggest that client-centered occupational therapy intervention provided within the home environment is beneficial for occupational performance, participation, role competence, and quality of life.     

An evaluation of transition in functional states among the elderly in Beijing, China

Objectives The goal of the present study was to describe the changes in activities of daily living (ADL) of community-dwelling Beijing elderly people (n=3,257), observed for 8 years, and to identify the demographic characteristic that predict the functional change. Methods Two sets of interview data (1992 and 2000) were used to evaluate changes among the elderly in reports of limitation in ADL management. Results The prevalence of disability increased over 8 years both in IADL and BADL disability. The patterns of ADLs change were bi-directional. A large proportion (74.7%) of the elderly were found to remain active in their functional states, 20.4% of the elderly declined, 3.4% of the elderly remained disabled, and 1.5% showed improvement in functional states. The transition rates from non-disability and disability states to various functional states showed different characteristic, a high disability rate accompanied a high mortality rate. The demographic factors that affected the level of disability among different kinds of population manifested similar trends. Conclusion Age was the most significant predictor for functional limitations. In addition, demographic variables played an important role in estimating functional outcomes. It is recommended that the demarcation factor for the evaluation of ADLs should be 75 years of age.     

Early evaluation of the risk of functional decline following hospitalization of older patients: development of a predictive tool

OBJECTIVE: To develop a predictive tool that could be used on admission to identify older hospitalized people at risk of functional decline 3 months after discharge. METHODS: This was a prospective cohort study that included 625 patients aged 70 years and older (mean age 80.0 +/- 5.6 years) hospitalized by the way of the emergency room, for at least 48 h, in two academic hospitals. Three months after discharge, 550 patients remained for analysis. On admission, people were assessed for premorbid functional status with the activities of daily living (ADL) scale and instrumental ADL scale. Demographic and medical data, including cognitive function, falls, polypharmacy, comorbidity, continence, mobility and self-rated health, were collected. ADL functioning was re-assessed at discharge and 1 and 3 months later. Functional decline was defined as the loss of at least one point on the ADL scale between the premorbid and 3-month evaluation. Univariate analyses were used to select variables associated with functional decline. A logistic regression model was then constructed to predict functional status 3 months after discharge. RESULTS: Three months after discharge, 165 (31.5%) patients had declined. The predictive tool SHERPA includes five factors: age, impairment in premorbid instrumental ADLs, falls in the year before hospitalization, cognitive impairment (Abbreviated Mini Mental State below 15/21) and poor self-rated health. Sensitivity and specificity were 67.9% and 70.8%, respectively. CONCLUSIONS: Older people are at high risk of functional decline following hospitalization. On admission, a simple instrument can easily identify these patients, even though the performance of this instrument is moderate.     

Community-based Occupational Therapy: A Study of Elderly People with Home Help in a Social-Welfare District in Stockholm

Since 1992 the local authorities in Sweden have been responsible for the rehabilitation of elderly people living at home. Few studies of this relatively new form of rehabilitation have been reported. The aim of this study was to describe the type of occupational- therapy interventions received by elderly people over the age of 65 living in an urban area. Another aim was to describe the patterns in the performances of 648 elderly people. The study demonstrated that most of the elderly people who received occupational therapy also received home help several times a day. indicating that these elderly people had severe problems in the activities of daily living (ADL) in the area of self-care. Home-making activities and activities outside the home were the most problematic activities. The elderly also wanted to engage in more activities than they were judged to have the capacity for and or the environmental support to do. The implications of the results for community-base, occupational-therapy programs are discussed.     

Interrater reliability of the Personal Care Participation Assessment and Resource Tool (PC-PART) in a rehabilitation setting

Background:  The Personal Care Participation Assessment and Resource Tool (PC-PART), formerly the Handicap Assessment and Resource Tool (HART), assesses the domains of clothing, hygiene, nutrition, mobility, safety, residence and supports.
Aim:  To examine the interrater reliability of the PC-PART in a rehabilitation setting.
Methods:  Assessments made by the researcher were compared to the interdisciplinary rehabilitation team. The research and standard assessments occurred within three working days. Raters were blind to each other's scores. Sample participants were a consecutive case-series of rehabilitation clients with varied diagnoses, activity limitations and participation restrictions. Of 66 consecutive patients seen during the a priori determined enrolment period, 25 were included in the study (nine males and 16 females, aged 44–85 years). The remaining 41 patients did not meet the inclusion criteria.
Conclusion:  The PC-PART has good interrater reliability. Clinicians, administrators and researchers can be reassured about this aspect of the validity of the tool.